Descending necrotizing mediastinitis secondary to retropharyngeal abscess.

We report a case of descending necrotizing mediastinitis (DNM) in a 68-year-old male who presented in acute respiratory distress accompanied with anterior cervical neck swelling and pain with swallowing. Contrast enhanced computed tomography (CECT) of the neck demonstrated a large, peripherally enhancing retropharyngeal fluid and air collection that appeared to communicate with a fluid and air collection within the mediastinum. CECT of the chest demonstrated punctate foci of air and fat stranding along the anterior and superior mediastinum. Radiological evidence and the presence of necrosis on surgical debridement of the retropharyngeal abscess established the diagnosis of DNM. This case emphasizes the role of computed tomography (CT) in the diagnosis of DNM and demonstrates the utility of chest imaging in a high-risk patient who presents with a retropharyngeal abscess.

Transient constrictive pericarditis following coxsackievirus A4 infection as a rare cause of acute mediastinitis: A case report.

Background: Transient constrictive pericarditis (TCP) is a distinct constrictive pericarditis (CP) subtype characterized by acute pericardial inflammation and transient constrictive physiology. If left untreated, it may progress to irreversible CP requiring pericardiectomy. However, making an early diagnosis of TCP remains difficult. Case presentation: A 51-year-old man presented with fever, chest pain, and dyspnea following preceding flu symptoms. An initial investigation suggested right-sided heart failure. Laboratory results revealed elevated inflammatory markers and hepatic enzyme levels. Echocardiography revealed pericardial effusion with a normal ejection fraction and diastolic ventricular septal bounce suggestive of pericardial constriction. Computed tomography suggested acute descending mediastinitis with pericarditis and pleuritis; however, detailed examinations ruled out this possibility. The constellation of increased serological inflammation, pericardial thickness/effusion, and constrictive physiology suggested TCP, confirmed by cardiac magnetic resonance (CMR) and hemodynamic studies. CMR also revealed coexistent myocarditis. After a thorough assessment for the cause of TCP, a viral etiology was suspected. Paired serology for virus antibody titers revealed a significant increase only in coxsackievirus A4 (CVA4) titers. With prompt anti-inflammatory treatment, the patient's pericardial structure and function and concomitant inflammation of the surrounding tissues were nearly completely recovered, leading to a final diagnosis of TCP caused by CVA4. The subsequent clinical course was uneventful without recurrence at the 1-year follow-up. Conclusions: Here we described the first case of TCP caused by CVA4 concurrent with mediastinitis, myocarditis, and pleuritis, all of which were successfully resolved with anti-inflammatory treatment. Acute mediastinitis secondary to TCP is rare. This case highlights the clinical importance of assessing pericardial diseases as a source of acute mediastinitis and considering CVA4 as an etiology of TCP. An evaluation including multimodal cardiac imaging and serology for virus antibody titers may be useful for an exploratory diagnosis of TCP in right-sided heart failure patients with pericardial effusion.

Survival rate of odontogenic descending necrotizing mediastinitis. Our experience in last 5 years

Background: Descending necrotising mediastinitis is one of the most lethal and least frequent forms of mediastinitis. It is a life-threatening infection most frequently originating from an oropharyngeal or odontogenic infection.Material and methods: A retrospective study of 6 patients diagnosed and treated for descending necrotising mediastinitis between 2015 and 2020 is reported.Results: All patients were male, mean age of 34.83 years; 66% were smokers. 83% had an orocervical infection and 34% had initial mediastinal spread. All patients were treated initially with empirical broad-spectrum antibiotics and surgical drainage, with subsequent admission to the Intensive Care Unit; only one of them required tracheostomy. The mean hospital stay was 27.37 days. After a mean follow-up of 6 months, 100% of the cases had a complete recovery.Conclusions: Early diagnosis and surgical treatment combined with improved life-support treatment in intensive care units and broad-spectrum antibiotic therapy leads to a decrease in associated mortality. (AU)

Acute Mediastinitis - Outcomes and Prognostic Factors of Surgical Therapy (A Single-Center Experience).

PURPOSE: The aims of this work were the retrospective analysis of a cohort of patients with acute mediastinitis treated at the authors' worksite over a 15-year period and the identification of factors that significantly affect the outcomes of the therapy. METHODS: During the period 2006-2020, 80 patients with acute mediastinitis were treated. Within the cohort, the following were observed: the causes and the type of acute mediastinitis, length of anamnesis, comorbidities, diagnostic methods, time from the diagnosis to surgery, types and number of surgical procedures, results of microbiological tests, complications, and outcomes of the treatment. RESULTS: The most common type of acute mediastinitis was descending mediastinitis (48.75%). A total of 116 surgical procedures were performed. Ten patients in the cohort died (12.5%). Patients older than 60 years were at a 6.8 times higher risk of death. Patients with more than two comorbidities were at a 14.3 times higher risk of death. The presence of yeasts in the culture material increased the risk of death by 4.4 times. CONCLUSION: Early diagnosis, removal of the cause of mediastinitis, sufficient mediastinal debridement, and multiple drainage thereof with the possibility of continual postoperative lavage are essential for the successful treatment of acute mediastinitis.

Acute mediastinitis, mediastinal granuloma, and chronic fibrosing mediastinitis: A review.

Acute mediastinitis is a rare infection that carries high morbidity and mortality. They are complications seen most often with deep sternal wound infections from surgeries with median sternotomies, oropharyngeal and odontogenic infections and esophageal perforations. These conditions should be promptly recognized and treated. Mediastinal granulomas are focal, mass-like lesions commonly resulting from prior granulomatous infections. They are regarded as benign, self-resolving lesions however can cause complications by compression of adjacent mediastinal structures. Chronic fibrosing mediastinitis is a rare, diffuse fibroinflammatory process most often seen with granulomatous infections and carries a worse prognosis than mediastinal granulomas especially when adjacent mediastinal structures are compromised. In this review, we discuss the epidemiology, etiology, clinical presentation, treatment and prognosis of acute mediastinitis, mediastinal granulomas, and chronic fibrosing mediastinitis.

Endoscopic ultrasound-guided transesophageal drainage for acute mediastinitis caused by pancreatic fistula.

Acute mediastinitis is a life-threatening condition, and standard treatment is percutaneous drainage and/or surgical treatment with antibiotics. A 58-year-old male diagnosed with acute mediastinitis originating from pancreatic fistula, detected only by endoscopic-ultrasound. We inserted a transesophageal nasocystic tube under endoscopic ultrasound guidance and successfully controlled the infection. The root of the main pancreatic duct for pancreatic juice drainage was recanalized using a duodenal endoscope. Endoscopic diagnosis and treatment by ultrasound have improved significantly; therefore, clinicians should know the potential of these procedures. The results of the present case may aid in the future treatment of patients with acute mediastinitis.

Purulent Pericarditis: Is It Really a Disease of the Past?

The authors present a case of purulent pericarditis probably secondary to respiratory infection, a rare entity in the antibiotic era. Pericardial fluid analysis identified streptococci and oral anaerobes as the causative agents. A prolonged and complicated diagnostic and therapeutic course, which included a long stay in the intensive care unit, is described, and a review of purulent pericarditis provided. Pericardial effusion, particularly in the setting of concomitant respiratory infection and immunocompromise or other risk factors, should raise the suspicion of bacterial pericarditis and prompt its timely diagnosis and treatment. Purulent pericarditis can be lethal and has potentially severe complications, so adequate antimicrobial therapy and source control are key. LEARNING POINTS: Purulent pericarditis is a rare infection, mostly resulting from contiguous or haematogenous spread, with diagnosis often delayed because signs and symptoms are unspecific.Treatment must include drainage of the pericardial space, combined with systemic antibiotics.Prognosis is variable, depending largely on the speed of diagnosis and treatment, as death is almost certain without adequate source control.

Imaging features and differential diagnoses of non-neoplastic diffuse mediastinal diseases.

Acute or chronic non-neoplastic diffuse mediastinal diseases have multiple causes, degrees of severity, and a wide range of management. Some situations require emergency care while others do not need specific treatment. Although the diagnosis may be suspected on chest X-ray, it is mainly based on CT. A delayed recognition is not uncommonly observed. Some findings may prompt the radiologist to look for specific associated injuries or lesions.This pictorial review will successively describe the various non-neoplastic causes of diffuse mediastinal diseases with their typical findings and major differentials.First, pneumomediastinum that can be provoked by extra- or intra-thoracic triggers requires the knowledge of patient's history or recent occurrences. Absence of any usual etiological factor should raise suspicion of cocaine inhalation in young individuals.Next, acute mediastinitis may be related to post-operative complications, esophageal perforation, or contiguous spread of odontogenic or retropharyngeal infections. The former diagnosis is not an easy task in the early stage, owing to the similarities of imaging findings with those of normal post-operative appearance during the first 2-3 weeks.Finally, fibrosing mediastinitis that is linked to an excessive fibrotic reaction in the mediastinum with variable compromise of mediastinal structures, in particular vascular and airway ones. Differential diagnosis includes tumoral and inflammatory infiltrations of the mediastinum.

Acute purulent mediastinitis with sequential bilateral pleural empyema caused by neck trauma: A unique occurrence, a case report.

BACKGROUND: Descending necrotizing mediastinitis (DNM) due to blunt trauma is very rare form of mediastinitis that can rapidly progress to septicemia and multi organ failure, in spite of optimal surgical management. CASE PRESENTATION: We report a 28-year-old patient, previously healthy man, with acute descending necrotizing mediastinitis and late sequential bilateral pleural empyema, caused by blunt neck trauma. Although after admission, the course of his illness was complicated with septic shock, homodynamic instability, renal and pulmonary insufficiency, however he survived with on time diagnosis, aggressive surgical intervention, appropriate antibiotics administration and optimal management in the intensive care unit (ICU). CONCLUSIONS: Descending necrotizing mediastinitis due to blunt neck trauma is a rare occurrence, but can lead to late sequential bilateral empyema even after 18 days. With early diagnosis, aggressive drainage and antibiotic therapy, the patient life can be saved. The lesson we took from this case is that: 1- blunt neck trauma rarely leads to descending necrotizing mediastinitis and late sequential empyema (even after 18 days). 2- If the patient does not recover from sepsis, despite optimal surgical management, contra lateral empyema or pericarditis should be considered.

Sepsis in Acute Mediastinitis - A Severe Complication after Oesophageal Perforations. A Review of the Literature.

BACKGROUND: Despite recent advancements in antibiotic therapy and the progress made in critical care and modern diagnostic methods, acute mediastinitis continues to be a severe condition. DIAGNOSIS AND TREATMENT: Acute mediastinitis can occur in the context of cardio-thoracic surgery, oesophageal perforations and oropharyngeal infections condition. Forty-five percent of oesophageal perforations occurs during simple endoscopy. Spontaneous perforation (Boerhaave syndrome) accounts for 15% of perforations, and twelve percent are due to the ingestion of foreign bodies. Other causes include blind or penetrating trauma, and circa 9% to intraoperative lesions. CT scan is the standard investigation that reveals direct signs of mediastinitis.The oral administration of contrast substances can underscore the level of oesophageal perforation. Conservative treatment is the first-choice treatment and surgical treatment is reserved only for specific situations.The principles of surgical treatment consist of drainage, primary suture, oesophageal exclusion with or without the application of oesophagectomy, endoscopic vacuum wound assisted therapy of the perforation and associated paraoesophageal mediastinal drainage and endoscopic stenting associated with drainage. CONCLUSIONS: The lowest mortality rate is recorded in patients with perforations diagnosed less than twenty-four hours after the onset of symptoms. Surgical treatment remains the gold standard especially in cases of thoracic and abdominal perforations while further investigations are mandatory before endoscopic stenting is carried out.

Caracterización clínica, diagnóstica y quirúrgica de pacientes con mediastinitis aguda por perforación esofágica cervical y torácica / Clinical, diagnostic and surgical characterization of patients with acute mediastinitis due to cervical and thoracic esophageal perforation

Se realizó un estudio descriptivo y transversal de 30 pacientes con mediastinitis aguda por perforación esofágica, operados en el Hospital Provincial Docente Clinicoquirúrgico Saturnino Lora Torres de Santiago de Cuba, con vistas a caracterizarles desde los puntos de vista clínico, diagnóstico y quirúrgico, desde enero de 1990 hasta agosto de 2016. La incidencia de la enfermedad fue de 37,9 por cada 100 000 habitantes con predominio de los pacientes jóvenes, en los cuales la esofagoscopia terapéutica por cuerpo extraño de difícil extracción fue la causa más frecuente de la perforación torácica, acompañada de síntomas y signos de síndrome esofágico y de sepsis, asociada a la presencia de estafilococos y estreptococos. La tomografía computarizada constituyó el examen de mayor valor para el diagnóstico, en tanto, los diferentes hallazgos durante la intervención quirúrgica estuvieron en dependencia del grado de infección mediastinal. Se necesita un conocimiento exhaustivo de los antecedentes, la clínica y posibles resultados de los exámenes complementarios para asumir una conducta rápida y eficaz, a fin de lograr la disminución de la mortalidad por dicha afección

A descriptive and cross-sectional study of 30 patients with acute mediastinitis due to esophageal perforation, who were surgically intervened at Saturnino Lora Torres Teaching Clinical Surgical Provincial Hospital was carried out in Santiago de Cuba from January, 1990 to August, 2016, aimed at characterizing them from the clinical, diagnostic and surgical points of view. The incidence of the disease was 37.9 out of 100 000 inhabitants with the young patients prevalence, in which the therapeutic esophagoscopy due to strange body of difficult extraction was the most frequent cause in the thoracic perforation, accompanied by symptoms and signs of esophageal syndrome and sepsis, associated with the staphylococci and streptococci presence. The computerized axial tomography constituted the exam of more value for the diagnosis, as long as, the different findings during the surgical intervention were in dependence of the grade of mediastinal infection. An exhaustive knowledge of the history, clinic and possible results of the complementary exams is necessary to assume a quick and effective behaviour, in order to achieve the decrease of mortality due to this disorder

Clasificación evolutiva y algoritmo de tratamiento quirúrgico de la mediastinitis aguda por perforación esofágica / Evolutionary classification and surgical treatment algorithm for acute mediastinitis through esophageal perforation

Introducción: la mediastinitis aguda constituye una complicación grave de la perforación esofágica. No existen clasificaciones ni pautas generales para su tratamiento. Objetivo: desarrollar una clasificación evolutiva, y un algoritmo de tratamiento quirúrgico. Métodos: se efectuó una investigación en el Hospital Provincial Saturnino Lora, de Santiago de Cuba, desde 1990 hasta el 2014. Se utilizó la prueba chi cuadrado de homogeneidad para la validación de los resultados, así como el porcentaje como medida de resumen y el calcula de las tasas de incidencia y de mortalidad. El estudio incluyó dos diseños metodológicos: el primero, de desarrollo tecnológico, para la elaboración de la clasificación y el algoritmo de tratamiento, y un cuasiexperimento, para la aplicación del algoritmo. Resultados: se identificó que en los estados más severos de la mediastinitis aguda, la mortalidad es más elevada. La carga de mortalidad para el primer grupo de pacientes fue del 77,7 por ciento y descendió al 22,3 por ciento en el grupo tratado con el algoritmo (decremento del riesgo del 64,8 por ciento). Conclusiones: la clasificación evolutiva pauta la implementación del algoritmo de tratamiento quirúrgico de la enfermedad. La aplicación del algoritmo de tratamiento quirúrgico de la mediastinitis aguda por perforación esofágica permite disminuir la carga de morbilidad. En consecuencia, disminuye de forma relevante el riesgo de morir por esta enfermedad(AU)

Introduction: acute mediastinitis is a serious complication of esophageal perforation. There are no classifications or general guidelines for its treatment. Objective: to develop an evolutionary classification and a surgical treatment algorithm. Methods: aresearch was carried out at Saturnino Lora Provincial Hospital in Santiago de Cuba, from 1990 to 2014. The chi-square homogeneity test was used for the validation of the results, as well as the percentage as a summary measure and the calculation of incidence rates and mortality. The study included two methodological designs: the first, technological development, for the elaboration of the classification and the treatment algorithm, and a quasi-experiment for the application of the algorithm. Results: in the more severe states of acute mediastinitis, mortality was identified as higher. The mortality load for the first group of patients was 77.7 percent and decreased to 22.3 percent in the group treated with the algorithm (risk reduction of 64.8 percent). Conclusions: the evolutionary classification guides the implementation of the surgical treatment algorithm of the disease. The application of the surgical treatment algorithm of acute mediastinitis through esophageal perforation allows reducing the burden of morbidity. Consequently, the risk of dying from this disease decreases significantly(AU)

Clasificación evolutiva y algoritmo de tratamiento quirúrgico de la mediastinitis aguda por perforación esofágica / Evolutionary classification and surgical treatment algorithm for acute mediastinitis through esophageal perforation

Introducción: la mediastinitis aguda constituye una complicación grave de la perforación esofágica. No existen clasificaciones ni pautas generales para su tratamiento. Objetivo: desarrollar una clasificación evolutiva, y un algoritmo de tratamiento quirúrgico. Métodos: se efectuó una investigación en el Hospital Provincial Saturnino Lora, de Santiago de Cuba, desde 1990 hasta el 2014. Se utilizó la prueba chi cuadrado de homogeneidad para la validación de los resultados, así como el porcentaje como medida de resumen y el calcula de las tasas de incidencia y de mortalidad. El estudio incluyó dos diseños metodológicos: el primero, de desarrollo tecnológico, para la elaboración de la clasificación y el algoritmo de tratamiento, y un cuasiexperimento, para la aplicación del algoritmo. Resultados: se identificó que en los estados más severos de la mediastinitis aguda, la mortalidad es más elevada. La carga de mortalidad para el primer grupo de pacientes fue del 77,7 por ciento y descendió al 22,3 por ciento en el grupo tratado con el algoritmo (decremento del riesgo del 64,8 por ciento). Conclusiones: la clasificación evolutiva pauta la implementación del algoritmo de tratamiento quirúrgico de la enfermedad. La aplicación del algoritmo de tratamiento quirúrgico de la mediastinitis aguda por perforación esofágica permite disminuir la carga de morbilidad. En consecuencia, disminuye de forma relevante el riesgo de morir por esta enfermedad(AU)

Introduction: acute mediastinitis is a serious complication of esophageal perforation. There are no classifications or general guidelines for its treatment. Objective: to develop an evolutionary classification and a surgical treatment algorithm. Methods: aresearch was carried out at Saturnino Lora Provincial Hospital in Santiago de Cuba, from 1990 to 2014. The chi-square homogeneity test was used for the validation of the results, as well as the percentage as a summary measure and the calculation of incidence rates and mortality. The study included two methodological designs: the first, technological development, for the elaboration of the classification and the treatment algorithm, and a quasi-experiment for the application of the algorithm. Results: in the more severe states of acute mediastinitis, mortality was identified as higher. The mortality load for the first group of patients was 77.7 percent and decreased to 22.3 percent in the group treated with the algorithm (risk reduction of 64.8 percent). Conclusions: the evolutionary classification guides the implementation of the surgical treatment algorithm of the disease. The application of the surgical treatment algorithm of acute mediastinitis through esophageal perforation allows reducing the burden of morbidity. Consequently, the risk of dying from this disease decreases significantly(AU)

Mortalidad a causa de perforación esofágica por mediastinitis aguda / Mortality due to esophageal perforation caused by acute mediastinitis

En situaciones de urgencia, la cirugía constituye un desafío a la pericia de los cirujanos, sobre todo cuando se trata de la perforación del esófago, que es una de las roturas orgánicas más graves y complejas de todo el tracto digestivo. Esto ocurre debido a las características anatómicas del órgano, que además, está rodeado de tejidos laxos y cavidades fasciales virtuales; por ello, su perforación permite que la infección se disemine rápidamente en el mediastino, la pleura y el pericardio, lo cual provoca que la mortalidad por mediastinitis aguda sobrepase el 60 por ciento.

Surgery constitutes a challenge to surgeons skill, in situations of emergency mainly when it is an esophageal perforation which is one of the most serious and complex organic breaks in the whole digestive tract. This happens due to the anatomical characteristics of the organ that is also surrounded by relaxed tissues and virtual fascia cavities; reason why, its perforation allows the infection to be quickly disseminated in the mediastinal cavity, pleura and pericardium, which causes that mortality due to acute mediastinitis exceeds the 60 percent.

Herniation of transverse colon into mediastinum after pedicled omental grafting for mediastinitis: report of a case.

We describe a rare complication and the treating experience of it after pedicled omental grafting for mediastinitis. The patient was diagnosed as an acute mediastinitis soon after the total arch replacement was performed. A two-staged strategy to treat postoperative mediastinitis was scheduled, i.e., the setting up of a vacuum-assisted closure system until the improvement of inflammation followed by wound closure with pedicled omental grafting. The treatment for acute mediastinitis was successful and the patient followed a favorable postoperative course. During the follow-up, chest X-ray film suggested the gradual enlargement of mediastinum and CT showed the herniation of transverse colon into mediastinum. Surgical correction for the hernia was scheduled and performed successfully by the laparoscopic procedure to prevent a possible cardiac and pulmonary dysfunction.

Acute mediastinitis in children: a nine-year experience.

BACKGROUND: Acute mediastinitis is a serious medical condition with a mortality rate of 30 to 40% or even higher. Early diagnosis with prompt and aggressive treatment is essential to prevent its rapid progression. We evaluated acute mediastinitis cases and analyzed the outcomes. MATERIALS AND METHODS: A retrospective chart review was conducted on patients diagnosed with acute mediastinitis who were admitted to Mofid Children's Hospital from January 2001 to January 2010. RESULTS: Seventeen patients aged 1 to 10 yrs. (mean =3.8 yrs) were evaluated including 12 (70%) boys and 5 (30%) girls. The most common symptoms were fever, dyspnea, cyanosis, tachycardia and tachypnea. The etiology of mediastinitis was iatrogenic esophageal perforation (EP), and related to manipulation in 13(77%), and leakage of esophageal anastomosis in 4 cases (33%). The underlying diseases were esophageal atresia in 2(12%), corrosive injury of the esophagus in 13(76%), congenital esophageal stenosis in one (6%), and gastroesophageal reflux esophagitis also in one (6%) patient. Patients with clinical symptoms were evaluated by immediate chest radiography, and gastrografin swallow. After early diagnosis, the patients received wide spectrum antibiotics and immediate mediastinal or thoracic drainage, followed by esophagostomy and gastrostomy. Only one case of endoscopic perforation was managed by NG tube. Fifteen patients (88%) survived successfully. We had 2(12%) cases of mortality in our study (one patient after esophageal substitution, mediastinal abscess and septicemia, and the other one developed esophageal perforation 6 months after early management and died of cardiac arrest during endoscopic dilation). CONCLUSION: Prevention of acute mediastinitis is still a difficult challenge. As the prognosis is not good and patients have high mortality, rapid management is mandatory.

Acute mediastinitis: evaluation of clinical risk factors for death in surgically treated patients.

BACKGROUND: Acute mediastinitis (AM) is the most lethal form of infection within the thorax. The authors of this study, using statistical tools, made an attempt to determine the most important clinical risk factors in retrospective material of patients treated surgically due to AM. METHODS: A total of 44 consecutive patients with AM were subjected to surgery. The aetiology was differentiated: iatrogenic (19), traumatic (11), descending mediastinitis (9) and neoplastic (5). A statistical analysis was performed using chi-square test with Yates correction and analysis of variance test to investigate the correlation between mortality and selected risk factors such as age, gender, aetiology, microbiology, delay between the diagnosis and surgery, coexisting diseases and the kind and number of post-operative complications. RESULTS: The general death rate was 31.82%. Aetiology was associated with mortality: neoplastic (100%), descending (33.3%), iatrogenic (26.3%) and post-traumatic (9.1%). The following types of bacteria were isolated: aerobes (65.9%), anaerobes (25%) and mixed flora (9.1%). The prognosis was not related to age, gender or the kind of the pathogen. The risk of death increased depending on the number of preoperative co-morbidities (P = 0.0446), particularly on the occurrence of a neoplasm (P = 0.0104). Early qualification for surgery (<24 h) resulted in lower death rate (P = 0.085). Manifestation of more than two post-operative complications (P = 0.0007) should be listed as one of the most negative risk factors. CONCLUSIONS: The knowledge of negative prognostic factors can appear to be a crucial tool enabling one to work out a better therapeutic strategy for high-risk patients with AM.

Mediastinite aguda: aspectos de imagem pós-cirurgias cardíacas na tomografia computadorizada de multidetectores / Acute mediastinitis: multidetector computed tomography findings following cardiac surgery

Mediastinite pós-cirurgias torácicas é definida como a infecção dos órgãos e tecidos do espaço mediastinal, ocorrendo em 0,4 por cento a 5 por cento dos casos. A gravidade da infecção pós-operatória varia desde infecção de tecidos superficiais da parede torácica até mediastinite fulminante com envolvimento esternal. O critério diagnóstico da tomografia computadorizada para mediastinite aguda pós-cirúrgica é a presença de coleção mediastinal, podendo estar associada ou não a anormalidades periesternais como edema/borramento de partes moles, separação dos segmentos esternais com reabsorção óssea marginal, esclerose e osteomielite. Achados associados incluem linfonodomegalias, consolidações pulmonares e derrame pleural e pericárdico. Pequenas coleções e gás mediastinais podem ser usualmente encontradas em pós-operatório recente de cirurgias torácicas sem a presença de infecções, limitando a eficácia da tomografia computadorizada nas duas primeiras semanas. Após esse período, a tomografia alcança quase 100 por cento de sensibilidade e especificidade. Pacientes com suspeita clínica de mediastinite devem ser submetidos a exame de tomografia para pesquisa de coleções, identificando a extensão da doença e sua natureza. A versão de multidetectores propicia recursos de reconstruções em diversos planos e janelas, contribuindo especialmente para o estudo do esterno.

Postoperative mediastinitis is defined as an infection of the organs and tissues in the mediastinal space, with an incidence ranging between 0.4 percent and 5 percent of cases. This disease severity varies from infection of superficial tissues in the chest wall to fulminant mediastinitis with sternal involvement. Diagnostic criterion for postoperative detection of acute mediastinitis at computed tomography is the presence of fluid collections and gas in the mediastinal space, which might or might not be associated with peristernal abnormalities such as edema of soft tissues, separation of sternal segments with marginal bone resorption, sclerosis and osteomyelitis. Other associated findings include lymphadenomegaly, pulmonary consolidation and pleural/pericardial effusion. Some of these findings, such as mediastinal gas and small fluid collections can be typically found in the absence of infection, early in the period following thoracic surgery where the effectiveness of computed tomography is limited. After approximately two weeks, computed tomography achieves almost 100 percent sensitivity and specificity. Patients with clinical suspicion of mediastinitis should be submitted to computed tomography for investigating the presence of fluid collections to identify the extent and nature of the disease. Multidetector computed tomography allows 3D images reconstruction, contributing particularly to the evaluation of the sternum.